Gorgojo-Martínez J J
Unidad de Endocrinología y Nutrición, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España.
Hipertens Riesgo Vasc. 2019 Jul-Sep;36(3):145-161. doi: 10.1016/j.hipert.2019.03.005. Epub 2019 May 10.
Cardiovascular (CV) disease is the most common cause of mortality in patients with type2 diabetes (T2DM). In recent years, several glucose-lowering drugs from two therapeutic families, GLP-1 receptor agonists (GLP-1 RAs) and sodium-glucose co-transporter type 2 inhibitors (SGLT-2i), have shown a reduction in CV morbidity and mortality in patients with T2DM and high CV risk. SGLT-2i, unlike GLP-1 RAs, also reduce the risk of hospital admission due to heart failure. Both therapeutic groups reduce the progression of diabetic kidney disease (DKD). The cardioprotective mechanism of SGLT-2i appears to be predominantly haemodynamic and shows an early onset, while that of GLP-1 RAs is mostly anti-atherosclerotic with a slow and progressive onset. At present, several scientific societies recommend the preferential use of GLP-1 RAs and SGLT-2i, with demonstrated CV benefit in patients with T2DM and cardiovascular disease or DKD.
心血管（CV）疾病是2型糖尿病（T2DM）患者最常见的死亡原因。近年来，来自两个治疗类别的几种降糖药物，即胰高血糖素样肽-1受体激动剂（GLP-1 RAs）和钠-葡萄糖协同转运蛋白2抑制剂（SGLT-2i），已显示出可降低T2DM和高CV风险患者的CV发病率和死亡率。与GLP-1 RAs不同，SGLT-2i还可降低因心力衰竭导致的住院风险。这两个治疗组均可降低糖尿病肾病（DKD）的进展。SGLT-2i的心脏保护机制似乎主要是血流动力学方面的，且起效较早，而GLP-1 RAs的机制大多是抗动脉粥样硬化的，起效缓慢且呈渐进性。目前，多个科学学会推荐优先使用GLP-1 RAs和SGLT-2i，它们已被证明对T2DM合并心血管疾病或DKD的患者具有CV益处。
